Disease transmission by blood transfusion continues to be a major concern because of the continued increase in the prevalence of AIDS and the lack of a specific test for non-A, non-B hepatitis. The health care costs of patients who develop post-transfusion hepatitis are over $150 million per year. The mission of this project is to reduce disease transmission by increasing the appropriate use of the patient's own predonated blood for elective surgery. Traditional medical education in the past 30 years has been ineffective: in January-February 1986, 94% of elective surgery patients who could predonate did not do so. Efficient and well-organized predonation programs are urgently needed. The investigators propose to develop model programs in the east, west and midwest areas of the country. The specific aims of the study are to determine why predonations are underutilized and to test whether an education program increases (1) the predonation rate and (2) the number of patients who actually benefit. The main target of education are surgeons because they order predonation. Chiefs of Surgery at the study sites believe that such a project is timely and important. Others targets are anesthesiologists, surgery clinic nurses, elective surgery patients and blood bank personnel. The program includes lectures, brochures, slides, tapes, posters, blood order forms and feedback reports. An estimated 9000 patients will be studied over 3 years. Other questions which will be answered included: what proportion of the blood supply can be predonated units, how often freezing blood is necessary for elective surgery patients, and how often clerical errors occur. "Model" programs are often not "modelled" at other institutions. A unique aspect of this proposal is the incorporation of a dissemination phase in years 4 and 5, when the program will be tested at 3 community and 15 teaching hospitals in different parts of the country.